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PT  - JOURNAL ARTICLE
AU  - Dewey, Blake E.
AU  - Remedios, Samuel W.
AU  - Sanjayan, Muraleetharan
AU  - Rjeily, Nicole Bou
AU  - Lee, Alexandra Zambriczki
AU  - Wyche, Chelsea
AU  - Duncan, Safiya
AU  - Prince, Jerry L.
AU  - Calabresi, Peter. A.
AU  - Fitzgerald, Kathryn C.
AU  - Mowry, Ellen M.
TI  - Super-Resolution in Clinically Available Spinal Cord MRIs Enables Automated Atrophy Analysis
AID  - 10.3174/ajnr.A8526
DP  - 2024 Oct 04
TA  - American Journal of Neuroradiology
PG  - ajnr.A8526
4099  - http://www.ajnr.org/content/early/2024/10/04/ajnr.A8526.short
4100  - http://www.ajnr.org/content/early/2024/10/04/ajnr.A8526.full
AB  - BACKGROUND AND PURPOSE: Measurement of the mean upper cervical cord area (MUCCA) is an important biomarker in the study of neurodegeneration. However, dedicated high-resolution scans of the cervical spinal cord are rare in standard-of-care imaging due to timing and clinical usability. Most clinical cervical spinal cord imaging is sagittally acquired in 2D with thick slices and anisotropic voxels. As a solution, previous work describes high-resolution T1-weighted brain imaging for measuring the upper cord area, but this is still not common in clinical care.MATERIALS AND METHODS: We propose using a zero-shot super-resolution technique, SMORE, already validated in the brain, to enhance the resolution of 2D-acquired scans for upper cord area calculations. To incorporate super-resolution in spinal cord analysis, we validate SMORE against high-resolution research imaging and in a real-world longitudinal data analysis.RESULTS: Super-resolved images reconstructed using SMORE showed significantly greater similarity to the ground truth than low-resolution images across all tested resolutions (p&amp;lt;0.001 for all resolutions in PSNR and MSSIM). MUCCA results from super-resolved scans demonstrate excellent correlation with high-resolution scans (r&amp;gt;0.973 for all resolutions) compared to low-resolution scans. Additionally, super-resolved scans are consistent between resolutions (r&amp;gt;0.969), an essential factor in longitudinal analysis. Compared to clinical outcomes such as walking speed or disease severity, MUCCA values from low-resolution scans have significantly lower correlations than those from high-resolution scans. Super-resolved results have no significant difference. In a longitudinal real-world dataset, we show that these super-resolved volumes can be used in conjunction with T1-weighted brain scans to show a significant rate of atrophy (-0.790, p=0.020 vs. -0.438, p=0.301 with low-resolution).CONCLUSIONS: Super-resolution is a valuable tool for enabling large-scale studies of cord atrophy, as low-resolution images acquired in clinical practice are common and available.ABBREVIATIONS: MS=multiple sclerosis; MUCCA=mean upper cervical cord; HR=high-resolution; LR=low-resolution; SR=superresolved; CSC=cervical spinal cord; PMJ=pontomedullary junction; MSSIM=mean structural similarity; PSNR=peak signal-to-noise ratio; EDSS=expanded disability status scale.